Evaluation of testicular function in prepubertal children
The assessment of testicular function is not currently performed in childhood. The aim of this review was to address the usefulness of serum Anti-Müllerian Hormone (AMH), inhibin B, and testicular volume (TV) evaluation in children.
Serum AMH and inhibin B levels reflect Sertoli cells (SCs) health and number, SCs maturation degree and their exposure to FSH and to intra-tubular testosterone (T). These hormones might be helpful in discriminating between congenital central hypogonadism (cHH) and constitutional delay in growth and puberty (CDGP) and in case of clinical suspicious of precocious puberty. Furthermore, low AMH and/or inhibin B levels have been observed in children with primary testicular disorders, suggesting the existence of SC dysfunction. TV also provides useful information on testicular health. Recently, a medical calculator, requiring testis length and the stage of genital development, has been developed to easily derive TV.
The evidence supports the usefulness of AMH, inhibin B and TV evaluation for the early diagnosis of puberty disorders and primary testicular damage. We suggest the measurement of TV by using the medical calculator in all children and to reserve AMH and inhibin B measurements to those cases of no testicular growth, clinical suspicious of puberty disorders or in children at risk for spermatogenesis damage. This work-up might allow the early detection of testicular tubular damage which, in turn, may be useful to prevent the oncoming male infertility in adulthood.
KeywordsAMH Anti-Müllerian hormone Inhibin B Sertoli cells Pre-pubertal children Testicular function
Gonadotropin-realizing hormone antagonist
Testicular distance to pubic bone
Compliance with ethical standards
Conflict of interest
The author declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
- 10.N.Y. Edelsztein, R.P. Grinspon, H.F. Schteingart, R.A. Rey. Anti-Müllerian hormone as a marker of steroid and gonadotropin action in the testis of children and adolescents with disorders of the gonadal axis. Int. J. Pediatr. Endocrinol. 20 (2016) https://doi.org/10.1186/s13633-016-0038-2.
- 11.C. Petersen, O. Soder, The Sertoli cell--a hormonal target and ‘super’ nurse for germ cells that determines testicular size. Horm. Res. 6, 153–161 (2006)Google Scholar
- 13.J. Young, P. Chanson, S. Salenave, M. Noël, S. Brailly, M. O’Flaherty, G. Schaison, R. Rey, Testicular anti-mullerian hormone secretion is stimulated by recombinant human FSH in patients with congenital hypogonadotropichypogonadism. J. Clin. Endocrinol. Metab. 90(2), 724–728 (2005)CrossRefPubMedGoogle Scholar
- 15.L. Adan, P. Lechevalier, A.C. Couto-Silva, M. Boissan, C. Trivin, S. Brailly-Tabard, R. Brauner, Plasma inhibin B and antimullerian hormone concentrations in boys: discriminating between congenital hypogonadotropichypogonadism and constitutional pubertal delay. Med. Sci. Monit. 16, 511–517 (2010)Google Scholar
- 22.S.S. Cao, X.O. Shan, Y.Y. Hu, Impact of unilateral cryptorchidism on the levels of serum anti-müllerian hormone and inhibin B. Zhonghua Nan KeXue. 22(9), 805–808 (2016)Google Scholar
- 24.J.J.Koskenniemi, H.E.Virtanen, C.Wohlfahrt-Veje, E.Löyttyniemi, N.E.Skakkebaek, A.Juul, A.M.Andersson, K.M.Main, J.Toppari, Postnatal changes in testicular position are associated with IGF-I and function of Sertoli and Leydig cells. J. Clin. Endocrinol. Metab. 103(4), 1429–1437 (2018). https://doi.org/10.1210/jc.2017-01889 CrossRefPubMedGoogle Scholar
- 27.M.G. Bastida, R.A. Rey, I. Bergadá, P. Bedecarrás, L. Andreone, G. del Rey, A. Boywitt, M.G. Ropelato, H. Cassinelli, A. Arcari, S. Campo, S. Gottlieb, Establishment of testicular endocrine function impairment during childhood and puberty in boys with Klinefelter syndrome. Clin. Endocrinol. 67, 863–870 (2007)CrossRefGoogle Scholar
- 28.L. Aksglæde, P. Christiansen, K. Sorensen, M. Boas, A. Linneberg, K.M. Main, A.M. Andersson, N.E. Skakkebaek, A. Juul, Serum concentrations of Anti-Mullerian Hormone (AMH) in 95 patients with Klinefelter syndrome with or without cryptorchidism. ActaPaediatr 100, 839–845 (2011)Google Scholar
- 31.T. Varimo, P.J. Miettinen, J. Känsäkoski, T. Raivio, M. Hero, Congenital hypogonadotropichypogonadism, functional hypogonadotropism or constitutional delay of growth and puberty? An analysis of a large patient series from a single tertiary center. Hum. Reprod. 32(1), 147–153 (2017)PubMedGoogle Scholar
- 37.J. Goede, W.W. Hack, K. Sijstermans, L.M. van der Voort-Doedens, T. Van der Ploeg, A. Meij-de Vries, H.A. Delemarre-van de Waal, Normative values for testicular volume measured by ultrasonography in a normal population from infancy to adolescence. Horm. Res. Paediatr. 76(1), 56–64 (2011)CrossRefPubMedGoogle Scholar
- 41.A. Juul, P. Bang, N.T. Hertel, K. Main, P. Dalgaard, K. Jørgensen, J. Müller, K. Hall, N.E. Skakkebaek, Serum insulin-like growth factor-I in 1030 healthy children, adolescents, and adults: relation to age, sex, stage of puberty, testicular size, and body mass index. J. Clin. Endocrinol. Metab. 78(3), 744–752 (1994)PubMedGoogle Scholar